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PFI2015-00198 CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT COMMUNITY DEVELOPMENT Permit#: PF12015-00198 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 01/04/2016 Parcel: SEG80 Jurisdiction: Tigard Site address: Subdivision: Lot: Project: PGE Project Description: Adjacent to 6617 SW Walnut Street. New 200A UG Service. Install 1 P 120/240 200A UG Service to Flag Lot House. Owner: FEES Description Date Amount PHONE: Contractor: PHONE: FAX Applicant: TSAHAI ANDERSON 10800 SW AVERY ST TUALATIN, OR 97062 PHONE: 503-612-6106 Total $0.00 Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact information of responsible parties before beginning work. Permittee/Applicant Signature: Not Present Issued By: Special Conditions(See Attached) Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY Conditions for PF12015-00198 Type: Condition Name: Status: Severi : PFI_Utilities 01 -WORK SITE REQUIREMENTS Applied Notice Applicant must comply with all applicable provisions of federal and state law,the Tigard Municipal Code, and the terms of any agreement with the City of Tigard regarding work to be done pursuant to this permit. PFI_Utilities 02-WORK SITE AREA Applied Notice The work area and approach roads shall be maintained in a clean condition, free from obstructions and hazards. The spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up and suspension of work to accomplish clean-up. PFI_Utilities 03-WORK SITE EROSION CONTROL Applied Notice Prior to starting work, effective and approved erosion control devices must be installed and maintained meeting the Clean Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to accomplish effective erosion control. PFI_Utilities 04-WORK SITE REPAIRS Applied Notice Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be reinstalled or replaced,with like kind of material. Obtain City approval of restoration work. PFI_Utilities 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices [MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services Association[ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH]. PFI_Utilities 06-TRAFFIC CONTROL PLAN Applied Notice Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work area. Traffic control devices, flag persons, etc., shall be in place prior to initiation of construction work and shall be effectively maintained. PFI_Utilities 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and area wide Emergency Services: 503-629-0111 (Tigard Police Dept., Tualatin Fire&Rescue)and to 503-962-8140(Tri-Met) and 503-431-2345(Tigard School District)and other service providers impacted by such closure. PFI_Utilities 08-TRAFFIC CONTROL PROPERTY ACCESS Applied Notice Access to existing properties shall be maintained at all times, including normal delivery service and mail service. Obtain City approval of any access closures. PFI_Utilities 09-TRAFFIC CONTROL WORK HOURS Applied Notice Work is permitted in daylight between the hours of 7:00 a.m. to 7:00 p.m. Mon-Fri unless otherwise authorized by the City. PFI_Utilities 10-TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m. to 9:00 a.m. unless authorized by the City Engineer. PFI_Utilities 11 -TRAFFIC CONTROL MODIFICATION Applied Notice The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to assure public safety. PFI_Utilities 12-UTILITY NOTIFICATION Applied Notice Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR 952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987. If you have any question about the rules, contact the Center. NOTE: Damage to utilities shall be corrected at the permit holder's expense. PFI_Utilities 13-UTILITY LOCATION CONFLICT Applied Notice Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work with affected utility agencies. PFI_Utilities 14-TEMPORARY PATCH Applied Notice A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is liable for hazards or damage resulting from the prosecution of the work. PFI_Utilities 15-REPAIR OF EXISTING FACILITIES Applied Notice Work under this permit shall include repair of existing facilities(roads, ditches,etc.)as may be necessary, as determined by the Inspector, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit. Corrective work shall be done at the applicant's expense. PFI_Utilities 16-PRECONSTRUCTION MEETING Applied Notice Before initiating any construction activity,the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert Phone#>,to establish a preconstruction meeting. PFI_Utilities 17-NOTICE TO COMMENCE WORK Applied Notice The applicant shall notify the City's Inspector twenty-four(24)hours prior to commencing work, prior to any staged inspection, and after completing work covered by the permit. PFI_Utilities 18-PERMIT/PLAN ON SITE Applied Notice A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan and all amendments shall be readily available at the work area. All work shall conform to the permit terms, conditions and provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work performance. PFI_Utilities 19-MONUMENT PROTECTION Applied Notice Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's expense. PFI_Utilities 20-EMERGENCY CONTACTS Applied Notice Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)persons who have authority to resolve problems, take corrective action and, in general,will be responsible in case of any emergency. The applicant shall notify the City Inspector, in writing, of any/all assignment changes. PFI_Utilities 21 -OTHER Applied Notice No road cut. RECEIVE® City Of Tigard DEC 3 0 2015 PUBLIC WORKS— ENGINI__IWGTIGAR[PGE WORK ORDER# M1950860 PLA ING/ENGINEERING Public Facility Improvement (PFI) Permit DESCRIPTION OF WORK(in the right-of-way) REQUIRED SUBMITTAL Check one: Iii Utilities ❑ Sidewalk/driveway approach ❑ Street improvements ELEMENTS Detailed description: New 200A UG Service N Minor work in right-of-way (sidewalk repair,curb cut,street Install 1 P 120/240 200A UG Service to Flag Lot House opening,etc.)requires: Application form,completed and signed Submit one(1)copy of scaled sketch Property address/location(s): AN 6617 SW Walnut Street of the proposed work to be done •Submit one(1)copy of traffic L LTJ control plan –OR– Tod Shattuck/Tsahai Anderson ❑ Substantial project work requires Applicant's name: above items and professional Address: 10800 SW Avery Street engineered plans for: Tualatin OR 97062 -Street widening City/state: Zip: -Subdivision infrastructure Phone: 503-672-5466 Email: T&DSupportAvery@pgn.com -Main utility line extension: Storm Drain,Sanitary—Tigard - Water—Tigard Water Service Contractor's name: Joe Hurd - Hollenbach 8c Hurd Excavator Area(includes Durham,Icing City CCB#: 121807 Expiration: and a portion of unincorporated Address: 3430 SW 209th Avenue Washington County) Beaverton OR 97007 DELIVER APPLICATION TO: City/state: Zip: -591-5987 Handh20@juno.com City of Tigard 503 Phone: Email: @1 Planning/E7:gineering 13125 SW Hall Blvd. Engineer's name: Tigard,OR 97223 Applications for"minor work in right-of-way" Address: only may be emailed to: City/state: Zip: rogpermitsktigard-or gov Phone: Email: Case No.: — 00,/ /tl Estimated value of work (within the public right-of-way): $ y Application submittal fee: Is work related to a LAND-USE DECISION? ❑ Yes p No Application accepted: If so,please specify (MLP, SDR, SUB, etc.) case #: By: LS� Date: Is work related to a BUILDING PERMIT? ❑ Yes BE No Applicati re ed: If so,please specify(BUILDING PERMIT)case#: By: Date: Applicant notified: /�{ /�� /1 .�./y By:�_ Date: (ok- � •J em4 u � I:\CURPIN\Mashrs\Land Use Apphutions Rev.07/16/2014 City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.tigard-or.gov - 503-718-2421 - Page I of 4 APPLICANTS NOTE: Person specified as "Applicant" shall be designated"Permittee"and shall provide financial assurance for work. *When the owner and the applicant are different people,the applicant must be the purchaser of record or a lessee in possession with written authorization from the owner or an agent of the owner. The owner(s)must sign this application in the space provided or submit a written authorization with this application. BY SIGNING BELOW,THE APPLICANTS) SHALL CERTIFY THAT: • The above request does not violate any deed restrictions that may be attached to or imposed upon the subs ce toti�oertr. • If the application is granted,the applicant will exercise the rights granted in accordance with the terms and subject to all the conditions and limitations of the approval. • All of the above statements and the statements in the plot plan,attachments,and exhibits transmitted herewith,are true;and die applicants so acknowledge that any permit issued,based on this application,may be revoked if it is found that any such statements are false. • The applicant has read the entire contents of the application,including the policies and criteria, and understands the requirements for approving or denying the application. SIGNATURES of each owner of the subject property required. Dig.M/sigr by TSANAI ANDERSON DNSNATSAHAIANDERSON =TgANDERSONQPGNCOM..-US Data:2015.12.30 1a39.22-08'00' TSahMI Anderson 12/30/15 Applicant/Authorized Agent's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date Owner's signature Print name Date PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard • 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 2 of 4 DEVELOPMENT ENGINEERING FEES 1. Public Facility Improvement(PFI)Permit: Part 1: Required submittal fee$300.00 Part 2: All non-water system improvements Engineer's estimate X 5% (less$300.00 submittal fee) Engineer's estimate X 2%Plan Review Part 3: All public water system improvements Engineer's estimate X 12% Total Permit Fee = Part 2+ Part 3 PFI Permit Fee Exemptions: There will be no permit fee charged,or assurance required for the following types of work: • Sidewalk or driveway repair(less than 20 lineal feet) • Relocate or replace mailbox • Ditch cleaning that does not involve regrading. • Weephole repair • Curb repair or replacement(less than 20 lineal feet) • Lawn sprinkler system installation or repair • Street tree pruning or planting • Planter strip landscape maintenance • Test wells PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard 13125 SW Hall Blvd. • Tigard,Oregon 97223 • www.tigard-or.gov 503-718-2421 Page 3 of 4 SAMPLE SKETCH: Edge of Pavement I -dW— Ditch Streetlight — —•—•---•— � a► •— —r--- I A nr ,� � r w� 1 � ' T—propos d�SeinrerTinne�' Nl I1 Existing House Existing 1 Driveway CI w I ;^• EL i t! 3 • o� a� a p+ >i I 1 O Existing Shop 1 = i Powerpole i I 1 -----776p W Lne-----.a_.—. I I Fire Hydrant irHydrant(FH) I j Scale: 1"=30' 1 I � I � � MINIMUM SKETCH REQUIREMENTS (Put'IN/A"if Not Applicable): North arrow Property lines &dimension Slope of property Street& street name(s) Existing building,structures Utility& street light poles Proposed work Existing curb or edge Trees Existing S/W or of pavement Existing utility locations D/W apron (sewer,water, storm) PUBLIC FACILITY IMPROVEMENT PERMIT City of Tigard - 13125 SW Hall Blvd. - Tigard,Oregon 97223 - www.tigard-or.gov - 503-718-2421 - Page 4 of 4 U) SM CIIE<KLIST 'i� 1991 rt@I YES COMOIT EDR I x - -- WL 5: TRENCH Install: Dc"TES '200A '120/240V FLAGGNG REETRIM '4,572AIC r NDDSSGA PE SINN, '1.75%FLK "RX CITU OF TIGARD '@3 TON RI D P .72%VD, G R EER WL 3-5 Span: 21T= X WL 3-VT 4: — Install: —„� Install: *(150')1-RUN OF 4/0 AL URD TX FACT R "1730 VT, '(150') 1 -3"PVC CONDUIT, PANY PROVIDED AND INSTALLED BY CUST PROVIDED AND INSTALLED BY CUST PAIL —Tl.F 00d Vicinity Map 1882`3 u -- WL 4: _ f SNE . TRANSFER: In + 'EXISTING 200A SVC 6617 SW WALNUT TERRACE IXN WL 2-3 Span: _ RRA,aL ]w Al7RT[`S I Install: -(50')l-RUN OF AL 350KCM TX Y '(50')1 -3"PVC CONDUIT, vr.r WL 3-4 Span: '2 PROVIDED AND INSTALLED BY CUST Install: CONSTRUCTION NOTES: SFEXT '(35')1-RUN OF 4/0 AL URD TX 1 CUSTOMER TOPROVDE ALL TRENCIHNGAND BACIIFELNG.JOINT USE TRENCH KITH GAS,TRENCH TO BE AS INCHES DEEP ANDD INCHES NIDE,MEASURED FRO) '(35')1 -3"PVC CONDUIT, °E C 1 ._C elDgl ].CONDUIT RF NECESSARY)YRLL BE GRAYS—DULE W.ELECTRICAL GRADE. SW WALNUT TER �lA< U PROVIDED AND INSTALLED BY CUST PVCCONDATN NYLON PUL-STRINGS NIN.5o0 L&S.TEST), I CIN AL POE TO DETERSNE TIE SIZE AND Nl1MSER OF CONIXIITS REWIRED. Remove: (;IAL NUNTAN IIVERTICAL_ES AND II HORIZONTAL INCHES CLEARANCE BETWEEN GAS AND OTHER UTILITIES ALL ELBOYA TOM 36INCH NINI RADIUS. ]7AO C2 CSCII ALLBENDS MVSTMFACTORYFUDE.RIGID STEELOR PGE APPROVED FIBERGLASS AD-T Open ]2 '1-RUN OF#2 TX,AL NEUT BENDS Aa EREOUIREDFORRUNSOFISIFEETORLONGER.ORFORANYLENGTR JOINT 4 _ 'DEADEND,WEDGE-GRIP, SMALL RUNYNTM ETMI IBOMGREESNRIWI.PVCSCHEWLEIOBENDSME ACCEPTABLE FOR RUNS O 150 FEET OR LESS,THE MA%MVA TOTAL BENDS IN ANT VCONDUIT RUN IS 770 DEGREES. 1AB06 AOd' ].OUSTOIER RE SPONSMLE FOR ROAD CROSSINGS.USE ONLY GRAY SONEOULE b, w4PLA ,-/ �S FBq/BV IQIG - ELECTRICAL GRADE.PVC CONDUITWIIIHIIYLDN L STRINGS RAIN.SOOLBS.)EST). 19x1 WL 1 .•L 2�PL 4232: A DIRECTIONAL BORING REQUIREMENTS:SUCK HDPE MOR DE NSITY POLYETNEUM)DUCT I n sta I I. CA SCHEDULE AO PJC VATH AMECHARICAL CONNECTION(CERTA-LOK OR UNG:MECIWBCAL 'OPEN FROM Install: CONNECTION PRODUCT)AS AN ALTERNIII£TO HOPE DICT.HDPE SHALL MEET THE REOUIREMENTS OF PGE SPEGIFcAIDON 2270515(AVABANE ON REQUEST FROM POE PROJECT f EZ TRUMD RED STRIPES MUCH ISA SPECIFICATION REOSMINI NT).NANDIIEL TEST OF 61034/50 1 P 25kVA OH 1201240 NT1 CB,7.2KV HDPE PIPE 11 RE OUIREDAFTER INSTA A ON W PGE NSPECTOR PRESENT. 'TRANS WIRING UNIT-25 KVA FUSED 1.TRANSFORMER XLLM�„B�D,D.T,QEI„EaDAMw..BGEI°^IDM `DRIVEN GROUND UNIT—COPPER6.ALLPGETRANSgiMERSTOBEINS LEO6F U(t�)FROAANYCLRMUSTRE `3-IN PVC CONDUIT UNIT W/1 21N BKTS UEDING NNLLOROVERHANGANDIFEETM1N)FROMANYNREHYgUNT PGE TRANSFORMERS MUST EI IMTHIN 15 FEET OF A DRIVEABLE AREA _ ALWAYS MAINTAIN IO FEET CLEARANCE IN FRONT OF ALL TRANSFOIMER9. CCASTD TRANSFER OH SVCS Ifl MFTRENCH R AND ELBOW CONROURl1TONS MUST BE INSPECTED BY PGE PRIOR TO PLEAS cAL WIHENYW ARE READY FOR POE N!INSPECT(AFTER INSTALLATION 16 COMPLETE) PLEASE CAL 50 WCRKH50 DR S F N]AB(SALEMAREA) ALLOW UP TO VAMNNO DAYS FON INSPECTION IOOCCUR. B. UNDERGROUND ND R URBANE DONSTNENTWA SE ANO TION EO ANCOST T.NONSTANDARD DESIGN S BASE ON ITMENTIAAUBEROPTION AT ANCOSTTDTHE-STONER . PGE POE DONSTRUC1/0N pAAW ND AS-BUILT VEMFTCATION 6 NESC VIOLATIONS CORRECTED CUSTOMER INFORMATION CONTACTSERWCECOORDINA10RR F—a, F TO SACRAL PGC U.NO INSTALL WIBC S[9Ftlp � t1.N1.IORDINS—BA Wm. SOcM£NG RENEWWIVASBUILTBYOESIG/ER- PGB.n.vyl -------- 8B77W54SO OR 5014"."WSALFM) 11/19RD15 11N=30FT Acco�NT 1070001 A 1950860 DEVLATION FROM TILLS DEAGN MUST nnF ' o T1kMCAN A APPRO VEDBYTREPGE PRO/ECT MAN ` VALBMRE CONSTRUCTION v A ®BctllE - CAMDEN HOME-III—.R T 17,27 - Is ��Bwcre aAc ITFNnOM: CALL 811 BEFORE YOU DIG PGE/ ABT 6617 SW WALNUT ST GON UW R[OUIR[S wN/TO FIXIDW IULFS ADOPTED NEW 20QA UG SVC THINK RIGHT-OF-WAY PERMIT NOTICE: BrTHE wrGGN uruNTr NDTNIunoNCENTER. � If M" 1="— �"MH�e I� A PERMIT FROM THE LOCAL JURISDICTION IS REQUIRED BEFORE ANY IINSF RUC rs ARF SEI fORTN N CAA 952-0OI-0Ol0 CII-250 INROUGN lSI-0OIO090 YOU MAY OIt NCOPIES Of INQTON 1 OF 1 SAFETY WORX IN THE RIGH)-0F-WAY MAY BE PERFORMED. ONLY PGE APPROVED THE RULES BY LAUI SME OREGON TUFF JOINT V..n....n wro Gs CONTRACTORS AND CONTRACTORS WHO HAVE MADE OTHER SPECIAL ARY—TION[f NTERADMNISIMIroN lISOI-132-Ila7. TOD SINTNCK 6725186 WLLEY SIEBERT FIRST AGREEMENTS WITHPGfWILLBfALLOWEDTOWORKUNDERPGE'SPERMIT. TO REQUEST UTILITY LOCATES CALL THE OREGON� + THE CONTRACTOR MUST NOTIFY THE LOCAL JURISDICTION 58 HOURS UTILITY NOTIFICATION CENTER,all AT LEAST Bad DBLIn YBR el4 BEFORE WORK IS TO BEGIN.A COPY OF THE PERMIT MUST BE ON SITE. 2 BUSINESS DAYS PRIOR TO EXCAVATION -mo •_ f . s. `rte 1FL ,&PROPOSED FLAG LOT 6617 SW Walnut Terrace l _ - , hLw Iti link SW VJValnut Terrace : i f: f �r